This study utilizes a case-control design to evaluate the relation between swimming lessons, swimming ability, and other risk or protective factors on the one hand, and the risk of drowning on the other. Information about risk and protective factors for childhood drownings will provide valuable guidance for the design of future interventions to prevent these tragic deaths. The primary study hypothesis addresses the association between swimming lessons and the risk of drowning among children ages 1 to 4 years, while secondary hypotheses address risk and protective factors for drowning among older children. Parents or guardians of drowning victims and parents/guardians of age-matched controls were interviewed. A short interview was also conducted with adolescent controls, aged 14-19 years. Interviews included questions regarding exposure to water, swimming ability, participation in swimming lessons, and a number of other factors that might influence the risk of drowning. Cases were identified from 19 Medical Examiners/Coroners offices in 6 states. Matched controls were identified through random-digit dialing. In the 1-4 year age group interviews were conducted with 61 families of drowning victims and 134 matched controls. A manuscript is currently under review. A manuscript reporting perceptions of case families with respect to participation in a study interview was published in May of 2007 in the Archives of Pediatric and Adolescent Medicine. The final study results demonstrated that 1-4 year old children who drowned were less likely than control children to have received formal swimming lessons. The adjusted odds ratio was 0.12 (0.01-0.97), suggesting that if causal, formal swimming lessons might reduce the risk of drowning in pre-school aged children by 88%.